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Full text of "Navy & Marine Corps Medical News 00-28"

The United States Navy on the World Wide Web 
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Navy S Marine Corps Medical News 

MN-00-28 

July 14, 2000 

Navy and Marine Corps Medical News (MEDNEWS) is a weekly 
compendium of news and information contributed by commands 
throughout the Navy medical department . Information contained 
in MEDNEWS stories is not necessarily endorsed by Navy Bureau of 
Medicine and Surgery (BUMED) , nor should it be considered 
official Navy policy. 

The BUMED distributes MEDNEWS to Sailors and Marines, their 
families, civilian employees and retired Navy and Marine Corps 
families . Further distribution is highly encouraged. 

Stories in MEDNEWS use these abbreviations after a Navy 
medical professional ' s name to show affiliation: MC - Medical 
Corps (physician) ; DC - Dental Corps; NC - Nurse Corps; MSC - 
Medical Service Corps (clinicians, researchers and 
administrative managers) . Hospital Corpsmen (HM) and Dental 
Technician (DT) designators are placed in front of their names. 

-USN- 

Contents for this week's MEDNEWS: 

- Short supply forces anthrax vaccination slowdown 

- Navy dental team provides humanitarian assistance 

- Hands-on training a plus for the Navy 

- Medical Enlisted Commissioning Program board to convene 

- Seeking award winning dental reservists 

- 'All in the family ' - serving and promoting together 

- TRICARE question and answer 

- Healthwatch: Dietary Supplements - things to consider 

-USN- 

Stories: 

Headline: Short supply forces anthrax vaccination slowdown 
By Rudi Williams, American Forces Press Service 

WASHINGTON - DoD ' s dwindling supply of anthrax vaccine has 
forced a temporary slowdown in inoculations, except to those 
personnel serving or about to serve in high-threat areas of 
Southwest Asia and South Korea, defense officials said during a 
July 11 Pentagon press conference. 

www.defenselink.mil/news/Jul2000/t01112000_t0111asd.html. 

Marine Corps Maj. Gen. Randy L. West, senior adviser to the 
deputy secretary of defense for chemical and biological 
protection, told reporters DoD has only about 160,000 doses of 
the vaccine on hand. He said DoD is trying to avoid suspending 
or shutting down the anthrax inoculation program. 

What ' s left of the vaccine is being largely reserved for 



the 10, 000 DoD people "with boots on the ground" in Southwest 
Asia and 37, 000 in South Korea, said Dr. J. Jarrett Clinton, 
first assistant to the assistant secretary of defense for health 
affairs . 

For the time being, most personnel in those areas who have 
begun the six-shot series will stop the inoculations if they 
rotate out . West said DoD guidance allows for local commanders ' 
discretion, so, for instance, rotating soldiers might still get 
shots because the 10-dose vaccine vials can only be used or 
discarded once opened. 

So far, 455,378 people have started vaccinations and have 
received a total of about 1.8 million shots. Some 56,725 have 
received all six shots, West said. During the slowdown, dosing 
will fall from about 75, 000 vaccinations monthly to around 
14,000. At that rate, DoD has enough vaccine to last up to 10 
months, he estimated. 

The mandatory six shots provide full protection as required 
by the FDA, West noted. He pointed out that receiving fewer than 
six shots causes no damage or harm to individuals , but does mean 
they lack the additional immunity protection provided by the 
complete series. 

Clinton said the first three shots are given in two-week 
intervals and the last three, six months apart. An annual 
booster shot keeps troops fully protected. Although a person 
gains some protection by the second or third shot, it takes the 
full six for full, sustained immunity, he said. 

Persons who have started the series but not finished will 
only need to pick up where they left off once their vaccinations 
resume, Clinton said. That's the guidance, he said, of the 
Centers for Disease Control ' s expert Advisory Committee for 
Immunization Practices. 

West attributed the slowdown to the inability of the sole 
contractor, Bioport of Lansing, Mich., to gain Food and Drug 
Administration approval for its production facility. He said 
immunizations will resume at full speed when the FDA approves 
and certifies a sufficient supply of vaccine as safe and 
effective, but he emphasized Bioport ' s own timetable doesn't 
call for its new vaccine to be available before the end of the 
year. 

"We 're disappointed because we wish we were vaccinating the 
whole force now. We're running about a year behind our planned 
schedule in this program, " West said. 

"When we began the program, there was an existing supply 
and there was one company that had a license, " he noted. "In 
retrospect, I wish that we would have immediately advertised for 
a second source. We did not. We recently have. " BioPort will 
cooperate with that second-source contractor, he said, and the 
FDA says that company could earn certification in two to four 
years . 

He said Britain and Russia have anthrax vaccines, but 
neither has FDA approval. The British vaccine is similar to the 
U.S. vaccine, but also in limited supply, and DoD has no 
interest in the Russians ' live-bacteria vaccine, West noted. 

He said intelligence reports indicate that the threat has 



increased since the anthrax vaccination program started in 1998. 
"There has also been an increase in the number of both state 
actors and nonstate actors that have done things that have 
prompted our intelligence committee to believe they are trying 
to obtain the capability (for biological weapons) . " 

But, West emphasized, "We 're less at risk than we were in 
1998, because we have more than 455, 000 people that have some 
protection and 56, 725 are fully protected. But we're less 
protected than we want to be. " 

-USN- 

Headline: Navy dental team provides humanitarian assistance 

By Air Force Capt. Denise N. Shorb U.S. Support Group East Timor 

DILI, East Timor - Two dentists and three dental 
technicians from 3rd Dental Battalion, Okinawa, Japan, provided 
dental services to the people of Dili and surrounding villages 
June 19-29. 

The Dental Civil Action Program team saw more than 400 
patients as one of the U.S. rotational presence units conducting 
humanitarian assistance projects, coordinated by U.S. Support 
Group East Timor (USGET) . 

"These people haven't had any kind of dental hygiene care 
or educational programs, " said It. Cmdr. Jorge Graziani, DC. 

"There' s a general lack of knowledge about how and why you 
should care for your teeth. They don't use toothbrushes and 
toothpaste, and they chew on nuts that discolor their teeth, " 
Graziani added. 

Accustomed to the conveniences of home, the team had 
several obstacles to overcome, including a language barrier. At 
one of the clinics they did not have a translator and had to 
rely on hand and face gestures . 

"People would come in and point to the tooth that hurt 
them. It was hard to explain to the patient that sometimes more 
teeth than just the one that hurt had to come out, " said 
Graziani . 

Another problem was with the electricity, or rather the 
lack of it . The instruments and equipped had a larger 
electrical current than the clinic at Bairo Pite Medical Clinic 
could support, so a generator was brought in. 

"Even then, we didn't have enough power to work both the 
sterilizer and the dental lamps, so we used flashlights instead 
of the lamps, " said DTI Paul Johnson. 

In Ermera, there was no power available at all, so 
instruments were sterilized the old-fashioned way - with boiling 
water. 

"We've only touched the tip of the needs here in East 
Timor, " said Capt. Gary Prose, DC. "We've taken care of an 
immediate need on a small part of the population. " 

"People need to be made aware of proper dental hygiene, " 
said Graziani . 

To assist the learning process, the team provided 25 dental 
textbooks at the Bairo Pite medical clinic. They also gave 
lectures on personal and oral hygiene at the schools in Ermera. 

This naval dental team was the second to visit East Timor 



with USGET. The first, an Air Force team, came through in 
April, and the USS FRANK CABLE (AS 40), a Navy submarine tender, 
provided additional dental assistance during their visit here in 
May. 

-USN- 

Headline: Hands-on trauma training a plus for the Navy 
By J02 Michael Howlett, Naval Hospital Bremerton 

BREMERTON, Wash. - The medical staff at Naval Hospital 
Bremerton is experiencing real life trauma through the 
collaboration efforts of the hospital and the largest civilian 
trauma center in the Northwest . 

Harborview Medical Center, Seattle, has an extensive 
outreach education program that hosts people from all over the 
region to do training, normally through observation. Since the 
military members are federally licensed, they are practicing 
vice shadowing the Harborview staff. In an exchange program, NH 
Bremerton staff perform training rotations at the medical 
center. 

"Our goal is to give our people a chance to experience a 
steady flow of trauma patients first-hand, " said Cmdr. Dennis 
Jepsen, NC, head of emergency department . "It gives us the 
chance to train and enhance our skills that we wouldn' t have the 
opportunity for here at the hospital. " 

This unique program combines civilian and military training 
techniques. It opens the door to increasing the effectiveness 
of training for Navy service members and helps to avoid cost by 
localizing advanced training rather than send service members 
cross-country for schools. The program also strengthens 
military ties with the local community by working together at 
the civilian hospitals . 

"Basically, we get the chance to provide continued training 
for our people, and Harborview gets some free help, " said Cmdr. 
Karen McNamara, NC, head of staff education and training. 

The Navy staff has few guidelines and limitations as part 
of the exchange. They must review a video explaining 
Harborview' s procedure for immobilizing people with suspected 
spinal injuries . They are not allowed to provide blood 
transfusions to patients, and they aren't expected to do all of 
the paperwork involved with patient care. 

The Navy staff will work in different areas of Harborview 
based on their specialties . In the future, service members will 
do rotations in the operating room, intensive care unit, and the 
hospital wards. 

-USN- 

Headline: Medical Enlisted Commissioning Program board to 
convene 

Applications are being accepted for the FY-01 Medical 
Enlisted Commissioning Program (MECP) . 

The MECP selection board will convene 11 Dec 00. Submit 
applications to Commander, Navy Personnel Command (Pers-811) , 
5720 Integrity Drive Millington, Tenn. 38055-8110, postmarked no 
later than October 1, 2000. All supplemental information must 



be postmarked no later than November 1, 2000, and must be sent 
via the applicant ' s commanding officer. 

A waiver of eligibility requirement will be granted for 
commissioning age of up to 40 years on a case by case basis. No 
other waivers will be considered. 

MECP applicants must have applied for admission to a 
nationally accredited school of nursing and must include, in 
their MECP application, an approved plan of study that 
demonstrates they can complete their program in 36 months or 
less. Those students who are selected for the MECP must submit 
their letters of acceptance to a qualified school of nursing to 
the Naval School Of Health Sciences, Code-OE, Bethesda, Md. 
20889-5022 no later than March 15, 2001. Applicants no longer 
require a letter of acceptance to a nursing school in order to 
apply for MECP. 

A routine HIV and drug screening within 18 months of 
October 1,2000 is required on the SF-88 (report of medical 
examination) . 

A list of applications received will be posted on the 
BUPERS homepage (www.bupers.navy.mil) under the PERS code icons: 
click on PERS-8, 81, in-service procurement branch, and MECP. 

For additional information contact Capt . Judy Logeman, NC 
or HM2 (FMF) Jeremy Wilkinson at 703-693-2324 . 

-USN- 

Headline: Seeking award winning dental reservists 

Commander Naval Reserve Force is requesting submissions to 
recognize outstanding performance of dental reservists in the 
dental community in support of active and reserve components for 
the annual Rear Adm. William J. H. Vaughn Memorial Awards. 

Naval reserve dental units, naval reserve dental officers 
0—5 and below, and naval reserve dental technicians E-6 and 
below are eligible to be nominated, provided the individuals and 
units were not award recipients within the preceding two years 
and three years, respectively . 

The submission deadline is October 31, 2000. All commands 
are encouraged to submit nominations to COMNAVRESFOR (N01M) , 
4400 Dauphine Street, New Orleans, La 10146. 

For additional information call HMCM Victor C. Harshbarger 
at (504) 618-1084; DSN 618-1084. 

-USN- 

Headline: 'All in the family'- serving and promoting together 
By J01 Maria Christina Mercado, NH Pensacola Public Affairs 

PENSACOLA, Fla. -It's been said a family that plays 
together, stays together. In some cases, they advance together 
too. That was the case recently when two generations of the 
Navy's medical community were promoted together. 

Father, Capt . Graeme Browne, MC, commanding officer of 
Fleet Hospital Minneapolis, and son, HM3 Damon Brown assigned to 
Naval Hospital Pensacola, were promoted to their current ranks 
in a joint ceremony at Naval Pensacola June 23. 

"We found out, about the same time, that we had been 
promoted. So, we thought it would be fun to do this together, " 



said HM3 Browne. 

After being promoted to the rank of captain, his wife and 
son replaced the shoulder boards on his uniform. 

"I am extremely proud of both of them, " said Margaret 
Browne, wife and mother. "The opportunity to come here and do 
this has been great. It really strengthens the bond between 
father and son. " 

Capt. Browne f rocked his son after he was promoted. "I had 
the pleasure three and a half years ago to enlist my son into 
the Navy, and it is with great pride I promote him to petty 
officer today, " said Capt. Browne during his son's f rocking 
ceremony . 

-USN- 

Headline: TRICARE question and answer 

Question: How do we obtain emergency care under TRICARE? 
And does the copayment increase for the emergency room? 

Answer: Any eligible beneficiary should access the nearest 
emergency room of any military or civilian hospital for true 
emergencies regardless of which TRICARE option you use. 

There are no out-of-pocket costs for any care received at a 
military hospital, including emergency room care. The out-of- 
pocket costs for care received at a civilian emergency room for 
families of E-4 and below enrolled in Prime is $10. For 
families of E-5 and above and retirees and their families the 
copay for an emergency room visit is $30. This single payment, 
$10 or $30, includes all emergency room services provided in 
conjunction with the visit. For those who have chosen to remain 
in TRICARE Standard or use the TRICARE Extra program, their 
regular deductibles and copayments apply. 

-USN- 

Headline: Healthwatch: Dietary Supplements - things to consider 
By LT Mike Prevost, PhD, Aeromedical Safety Officer, Marine 
Aircraft Group 39 

Camp Pendleton, Calif. - According to the Dietary 
Supplement, Health and Education Act (DSHEA) , dietary 
supplements are products (other than tobacco) intended to 
supplement the diet . They are products that bear or contain one 
or more of the following dietary ingredients: a vitamin, a 
mineral, an herb or other botanical, an amino acid, a dietary 
substance for use by man to supplement the diet by increasing 
the total daily intake, or a concentrate, metabolite, 
constituent, extract, or combinations of these ingredients. In 
addition the product must also be labeled "dietary supplement" . 

The intent of the DSHEA was to make a wide variety of safe 
and effectively labeled products readily available to consumers. 

But according to official definition almost any substance 
can be considered a dietary supplement by simply marketing it as 
a supplement (if it is not already marketed as a drug) . 

Under the DSHEA it is a manufacturer's responsibility to 
ensure that its products are safe and properly labeled prior to 
marketing . 

The FDA does not approve or disapprove new supplements , 



which allows manufacturers to bypass the extensive studies 
required to establish effectiveness and safety prior to the 
release of a new drug. 

Clinicians, health care providers and health care educators 
are presented with a considerable dilemma when providing advice 
and guidance on the use of dietary supplements. Even if there 
is ample convincing evidence to suggest that a product is 
effective and safe, there is no way to guarantee the purity or 
accuracy of dose of the product. This makes it difficult to 
recommend any product . 

It also creates another dilemma. If the health care system 
takes a negative view of dietary supplements, the patient may 
dismiss the health care system as a valuable source of 
information on dietary supplements . Instead they may choose 
more biased, misleading or inaccurate sources of information. 
It is difficult for health care professionals to compete against 
slick advertisements promising very attractive benefits. 

The problem is compounded by the fact that the "quick fix" 
promised by supplement manufacturers is often much more 
attractive than the alternatives provided by health care 
professionals (i.e. exercise, diet, surgery, medications, 
lifestyle modifications) . 

Health care professionals must be willing to talk to 
patients about dietary supplements so they will not seek out 
alternate sources to gather information, which may be biased, 
misleading and inaccurate. 

A proactive approach will be more successful than a 
reactive approach. Discussing the effectiveness and safety of 
some of the more popular products pertaining to the patients ' 
particular situation, for example obesity and weight loss. The 
health care professional might also discuss common advertising 
gimmicks and perhaps point out some examples of misleading 
advertisements so that the patient is made fully aware of 
products . 

There are four major negative consequences that health care 
professionals should consider before providing guidance or 
advice on the use of dietary supplements: 

- Almost any substance can be marketed as a dietary supplement . 

- The FDA does not test dietary supplements for safety prior to 
sale. 

- The FDA does not routinely test dietary supplements for purity 
or accuracy of dose prior to sale. 

- Manufacturers can make nutritional support claims without 
substantial scientific evidence. 

-USN- 

Comments about and ideas for MEDNEWS are welcome . Story 
submissions are encouraged. Contact MEDNEWS editor, at email: 
mednews@us.med.navy.mil telephone 202/762-3218, (DSN) 762, or 
fax 202/762-3224. 

-USN-